title: Hospital variation in postoperative infection and outcome after congenital heart surgery.
abstract: BACKGROUND
  Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery.
  
  
  METHODS
  The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to resource utilization data from the Pediatric Health Information Systems Database for hospitals participating in both (2006 to 2010). Hospital-level infection rates (sepsis, wound infection, mediastinitis, endocarditis, pneumonia) adjusted for patient risk factors and case mix were calculated using Bayesian methodology, and association with hospital mortality rates, postoperative length of stay (LOS), and total costs evaluated.
  
  
  RESULTS
  The cohort included 32,856 patients (28 centers); 3.7% had a postoperative infection. Across hospitals, the adjusted infection rate varied from 0.9% to 9.8%. Hospitals with the highest infection rates had longer (LOS) (13.2 vs 11.7 days, p < 0.001) and increased hospital costs ($71,100 vs $65,100, p < 0.001), but similar mortality rates (odds ratio 0.99, 95% confidence interval 0.80 to 1.21, p = 0.9). The proportion of variation in costs and LOS explained by infection was 15% and 6%, respectively.
  
  
  CONCLUSIONS
  Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA. pasquali@med.umich.edu
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: 20; 21; 4